Basic Information
| Provider Information | |||||||||
| NPI: | 1538686415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROZEK | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | RAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 RIDGECREST DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486425860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898392290 | ||||||||
| FaxNumber: | 8442734297 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 RIDGECREST DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486425860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898392290 | ||||||||
| FaxNumber: | 8442734297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.